The Lord Bishop of Portsmouth: My Lords, there is a saying that health is not valued until sickness comes, and that has certainly been my experience over the past six months, whether the word "health" means my own health or it means the health service. This debate is timely and I thank the noble Baroness for arranging it, and for her kind words, because if my calculations are correct, while the Minister was celebrating the anniversary of his arrival on this planet on 8 September last year, I was making preparations for my possible premature departure from it after being diagnosed with acute myeloid leukaemia. From that time until mid-January I spent about 11 and a half weeks in the tender and highly competent hands of the haematology unit of the Queen Alexandra hospital in Portsmouth. Perhaps I may place on the record not only my thanks to many noble Lords for their good wishes during my time away, but also my profound appreciation to Dr Mary Ganczakowski and her colleagues, to Kay Heran and Sue Thomas—who is no relation of the noble Baroness of that name—and their nurse colleagues. Without their professionalism, I would not be here to tell the tale. I can assure your Lordships that I am very much alive and kicking, and it must be the Viking genes in my bone marrow.
	I am aware that this is rightly a very technical debate. The fates have decreed that it comes when the National Health Service has entered the very forefront of public concern this week. As someone who could be described as a consumer rather than a professional, I want to confine my remarks to three areas: co-ordination, choice and stability. First, I turn to co-ordination. One of the issues arguably facing the NHS is continual reorganisation. Of course organisations sometimes need to be reorganised, but I have to say that the current plans to reorganise the PCTs—I live in the thick of one of those: Fareham, which has overspent considerably—could not be worse timed. I say that in the light of the recently announced plans to reorganise local government. Surely the cart is before the horse, or whatever image comes to mind.
	The balance is always between micro and macro management, but both are needed and it is a question of collective agreement and long-term policy about where each properly lies. The current plans have been severely criticised by the House of Commons Health Committee both because they come only three years after the previous reorganisation and because they are likely to set National Health Service organisations back by 18 months, with adverse effects on patient services. As a recently discharged patient, and I want to assure noble Lords that there are no special episcopal perks in the NHS aside from the odd joke, I want to be reassured that this will not be the case—and not just for acute treatment, but for other more day-to-day, non life-threatening programmes. I am concerned, for example, that drastically imposed economies on such apparently small, but for patients and their families highly significant issues as parking charges, do not get imposed. We were lucky in that respect.
	I do not want to labour the point unduly, but one of the most important keys to the well-being of a society is how it treats its most vulnerable people. Over the 10 years that I have been Bishop of Portsmouth, I have watched the Haslar hospital saga, and the growing consensus on the PFI at the Queen Alexandra hospital. While I have to say that the planned eventual closure of Haslar is not good news for Gosport—and I do try to keep the big picture in front of me—far too often one of the subtexts of the PFI plan seemed to paint a fanciful picture of a new building with plenty of land around and unlimited parking space, surrounded by a motorway ring road with easy access for all and sundry, including from the Isle of Wight, which is manifestly far from the case. Co-ordination means many things, from ensuring that patients do not suffer from casual or long-term economies to an adequate transport system—I am thinking of natal units as well as emergency cardiac treatment.
	Secondly, there is the issue of choice. I am afraid that the shibboleth about choice needs a bit of debunking. I am not against choice. I am glad that there was an array of newspapers in the service station on the M3 this morning. But when, after a gruelling weekend of three big services in unusually hot weather at the end of August last year, I realised that I needed to see my GP, I am glad that I was able to do so on that Monday morning and quickly. That is what people want. I would have gone in the evening if I had had to do so, but at least I got there.
	If I may speak for the church community with regard to consumerism, I was grateful to receive communion on Sunday mornings from whatever chaplain was available, regardless of denomination, and the form of service was not something about which I was prepared to grumble—especially during chemotherapy—or even write a letter to the local bishop, as that would be me. Moreover, I know that there are growing concerns among doctors, both general practitioners and those who work in hospitals, and among nurses, about the long-term effect of the rhetoric of choice on ordinary people's expectations. I am sure that this has played a part in the attacks on nurses that received national news coverage recently. Choice, whether we like it or not, is part of contemporary culture, and I echo the words of the noble Baroness. Perhaps the kind of reflective and more wisdom-based rather than technocratic changes that are needed should try to shift the language of public debate more in the direction of manageable, limited outcomes, in order to prevent an increasing outbreak of false expectations. Choice in healthcare may be relevant to some elective surgery, short-term treatments or diagnostic procedures, but it is far less appropriate for life-threatening or chronic conditions. When I was diagnosed, I did not want or need choice. What I needed and got was the security of immediate care, which in all its respects gave me the confidence to keep going, especially in those difficult early weeks.
	Thirdly, there is the issue of stability, by which I do not mean, "Stop the world, I want to get off," and nor do I mean no change—far from it. However, all organisations need a collective culture that builds up a sense of identity, with loyalty and allegiance as essential parts of its well-being. Charles Swinburne, the 19th century writer, may have been in one of his sharper moments when he wrote:
	"Body and spirit are twins; God only knows which is which".
	Part of any care organisation involves attending to both, however defined, religiously or not. There are inevitable positive spin-offs not only for the patient but for the whole ward.
	I do not envy a Labour Government having to face up to what is happening to one of their most precious jewels with which I grew up. There is a collective desire to get out of the mess. Briefly, I want to offer some advice from my work. If I want to set in motion a diocesan initiative, I know that I must convince a lay reader up the Meon valley, a church warden in inner urban Portsmouth and a country vicar in rural West Wight. I know that their first two questions to me will be: how does this initiative relate to the last one in addressing its weaknesses and building on its strengths; and how will it change things for the better on my patch?